Utility of FIB4-T as a Prognostic Factor for Hepatocellular Carcinoma

Abstract

Background: Most integrated scores for predicting the prognosis of patients with hepatocellular carcinoma (HCC) comprise tumor progression factors and liver function variables. The FIB4 index is an indicator of hepatic fibrosis calculated on the basis of age, aspartate aminotransferase (AST) levels, alanine aminotransferase (ALT) levels, and platelet count, but it does not include variables directly related to liver function. We propose a new staging system, referred to as “FIB4-T,” comprising the FIB4 index as well as tumor progression factors, and examine its usefulness. Method: Subjects included 3800 cases of HCC registered in multiple research centers. We defined grades 1, 2, and 3 as a Fibrosis-4 (FIB4) index of <3.25, 3.26–6.70, and >6.70 as FIB4, respectively, and calculated the FIB4-T in the same manner in which the JIS (Japan Integrated Staging Score) scores and albumin-bilirubin tumor node metastasis (ALBI-T) were calculated. We compared the prognostic prediction ability of FIB4-T with that of the JIS score and ALBI-T. Results: Mean observation period was 37 months. The 5-year survival rates (%) of JIS score (0/1/2/3/4/5), ALBI-T (0/1/2/3/4/5) and FIB4-T (0/1/2/3/4/5) were 74/60/36/16/0, 82/66/45/22/5/0 and 88/75/65/58/32/10, respectively. Comparisons of the Akaike information criteria among JIS scores, ALBI-T, and FIB4-T indicated that stratification using the FIB4-T system was comparable to those using ALBI-T and JIS score. The risk of mortality significantly increased (1.3–2.8 times/step) with an increase in FIB4-T, and clear stratification was possible regardless of the treatment. Conclusions: FIB4-T is useful in predicting the prognosis of patients with HCC from a new perspective.

Serum Zinc Level Is Associated with Frailty in Chronic Liver Diseases

“…), liver fibrosis markers (e.g., FIB4 index > 3. 25), and/or laboratory data (e.g., lower platelet count or prolonged prothrombin time) [26][27][28][29][30].…”

An Integrated Fibrosis Signature for Predicting Survival and Immunotherapy Efficacy of Patients With Hepatocellular Carcinoma

“…A previous study reported that there are three distinct TME phenotypes in HCC that are prominently associated with prognosis, immune surveillance, immune escape, and genetic alterations ( Liu et al, 2021e ). Liver fibrosis indicates tremendous potential in tumorigenesis and tightly correlates with prognosis ( Kariyama et al, 2019 ). Inflammation bursts and the immune responses activate hepatic stellate cells (HSCs) and favor extracellular matrix (ECM) deposition, leading to liver fibrosis ( Koyama and Brenner, 2017 ; Mack, 2018 ).…”

Potential role of Fibrosis‐4 score in hepatocellular carcinoma screening: The Kangbuk Samsung Health Study

“…The FIB‐4 score was used to define the risk of advanced fibrosis as follows: <1.30 (“low risk”), 1.30–2.67 (“intermediate risk”), and ≥2.67 (“high‐risk”) 33 . Additionally, based on previous research findings of enhanced HCC diagnostic performance with increasing FIB‐4 scores, we conducted an investigation to assess the results based on varying FIB‐4 score cutoff values 34–37 …”

“…33 Additionally, based on previous research findings of enhanced HCC diagnostic performance with increasing FIB-4 scores, we conducted an investigation to assess the results based on varying FIB-4 score cutoff values. [34][35][36][37]…”